Incorporating a Web-based, Integrative Medicine Curriculum into 8 Family Medicine Residencies: Keys...
-
Upload
cody-chapman -
Category
Documents
-
view
219 -
download
5
Transcript of Incorporating a Web-based, Integrative Medicine Curriculum into 8 Family Medicine Residencies: Keys...
Incorporating a Web-based, Integrative Medicine Curriculum into 8 Family Medicine Residencies: Keys to Success
Victoria Maizes, M.D., Victor Sierpina, M.D., John Woytowicz, M.D., Selma Sroka, M.D., Sally Dodds, Ph.D., & Patricia Lebensohn, M.D.
Presentation Objectives
• The objectives of this presentation are:
▫ Recognize the steps in creating competency-based education including the evaluation methodology.
▫ Understand program strategies used in incorporating a new curriculum into existing residency training.
▫ Review key outcomes of courses completed and change in IMR medical knowledge.
▫ Review individual program successes and challenges in implementation methodology.
Integrative Medicine in Residency (IMR) is…
• Competency-based, online, 200-hour, curriculum.• In-depth training in Integrative Medicine.• Incorporated through all 3 years of Family Medicine
residency.• Piloted at 8 residencies nationwide.• Seamless, online evaluation of the curriculum and the
residents.• Responds to ACGME competency requirements.• Evaluation developed simultaneously with the
curriculum.
University of Arizona
University of Texas Medical Branch
Hennepin County
Carolinas Medical Center
Beth Israel
Maine-Dartmouth
Maine Medical Center
University of Connecticut
IMR Program Locations
Moses H. Cone
Alaska Family Medicine
Univ. of Minn
A. Einstein Montefiore
Control sites
Tools in Integrative Medicine
Prevention and
Wellness
Women’s Health
Chronic Illness
Pediatrics
Acute Care
IMR Curriculum Units
Introduction to Integrative Medicine
Prevention and Wellness:• U.S. Preventive Health Services• Nutrition and Diet • Supplements for Prevention• Physical Activity• Sleep • Stress and Mind-Body Medicine • Spirituality• Clinical Integration
Tools in Integrative Medicine:• Integrative Medicine Intake and Care Plan • Botanicals• Mind-Body Medicine• Manual Medicine • Introduction to Energy Medicine and Whole
Systems • Practice Management• Motivational Interviewing for Behavioral
Change
Acute Care:• Acute Back Pain,• Urinary Tract Infection,• Gastroenteritis,• Otitis Media,• Vaginitis,• Atypical Chest Pain,• Upper Respiratory Infection
Pediatric Topics:• ADD/ADHD• Chronic Pain Syndrome• Asthma and Allergies
Women’s Health Topics:• PMS/PMDD• Dysmenorrhea• Menopause• Fibromyalgia• Osteoporosis • Depression • Eating Disorders • Pregnancy and Lactation
Chronic Illness: • Cardiovascular Disease• Type II Diabetes• Osteoarthritis • Rheumatoid Arthritis• Obesity • Irritable Bowel Syndrome• Chronic Back Pain
Special Topics:• HIV/AIDS • Cancer Survivorship• Environmental Medicine
Units and Courses
IMR: Educational Methods Needs assessment informed curriculum design. Web-based curriculum written and edited by Integrative
Medicine educators. Competencies aligned with the ACGME Outcomes
Project. Flexible modular format to meet the needs of
residency schedules. Case-based, interactive learning and streaming video. Experiential exercises and process-oriented group
activities at the residency sites. A community of learners through online dialogues with
faculty and peers. Emphasis on teaching and promoting physician well-
being and self-care.
IMR User Interface
Online portfolios
Flexible modular format
Resources and Links
Direct Observation Checklists
Reflections
What is Evaluated in the IMR?
• Curriculum:▫ Residents evaluate each course after completion
• Residents’ competencies:▫ Medical Knowledge test▫ Self Assessment▫ Direct Observation Checklist▫ Reflections
• Residents’ wellness & well-being:▫ Behavioral assessments
• Residency recruitment:▫ Match results and post match survey
As of March 19, 2010
Yr 01 Course CompletionsClasses of 2011 and 2012
Intro
Preve
ntion
Nut.
& D
iet
Supple
men
ts
Phys. A
ctivity
Sleep
Spiritu
ality
Stres
s & M
-B
Clinic
al In
teg
100% 99%94% 92% 92% 90% 90% 90% 88%85%
72%
56%
44%50%
41% 41% 40%
29%
2011 2012
As of March 19, 2010
Yr 02 Course CompletionsClass of 2011
IM In
take
Mot
Intv
Botan
ic
M-B
Pra
ct
Acute
car
e
Pedia
trics
ADHD
Ped A
llerg
yPai
n
Wom
en
PMD/P
MDD
Dysm
en
Pregn
ancy
Eatin
g Dis
Fibro
my
Depre
ssio
n
Wom
en IC
S
Men
op
Osteo
por
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
23%18%18%15%
37%
64%
44%
55%
38%
62%54%
48%40%38%
34%28%29%32%29%
Clinical Utility of the Course?Year 01 Content
*Currently, indicators are available for 4 courses for the 2012 class.
Meet Learning Objectives? Clinical Utility?
Year 02 Course EvaluationsCourses currently at 50% threshold
Year 02 Course EvaluationsCourses currently at 50% threshold
Smooth Online technology?
2011 (58) 2012 (62) Controls (27)
48.7% 51.4% 54.1%
Yr. 01
Medical Knowledge TestMean percent correct at baseline – All groups
ns
Medical Knowledge TestSub group differences at baseline – Class of 2011
Sex Medical School Status
Se-ries1
0.526
p = .007
Males Females
Series1
53.9% 55.7%
33.5%
p . < .001
US - MD US - DO FMG
Series1
48.8%57.8%
Baseline 1st Post-test
Medical Knowledge TestPre-/Post Test Class of 2011 – Yr. 01
2011 2012 2013
51%
41%
58%
44% 42% 45%
18%
26%
17%
27% 28% 26%
4% 5%0%
US MD National US DO FMG Unk
Post Match1
Match Results 2011, 2012, 2013
Post Match2
IM/CAM Medical School Courses &Personal Use
Controls rated higher than 2012 group on all questions.
* 2011 more required IM/CAM courses in medical school than 2012 (p<.001).
* 2011 more electives in medical school than 2012 (p<.001).
* Controls more electives than 2012 (p=.012).
* 2011 more personal IM/CAM use than the 2012 group (p=.014).
Required course
Elective Personal use
75%
63%67%
35%
21%
42%
57%
50%53%
2011 2012 Controls
2011 (n=57)2012 (n=43)Control(n=30)
Post Match3
Interest in Learning IM in Residency
High interest in both the 2011 and 2012 groups.•But, over half of the controls also had high interest.
* 2011 group had a higher interest than controls (p=.002).
High/Mod-erate
Neutral Some/Not at all
0.88
0.12
77%
7%
25%
60%
23%17%
2011 2012 Controls
2011 (n=57)2012 (n=43)Control(n=30)
Post Match4
Importance of the IMR in Ranking Decision
Very important/Important:•2011 – 53%•2012 – 37%
Notes:1. Likert scale revised to 5 points and
accounts for differences in scores.
2. 2011 totals >100%– rounding error .
Hig
h/M
oder
ate
Impo
rtan
t
Neu
tral
Somew
hat
Not
Impo
rt
28%25%
21%27%
14%
23%28%
14%
21%
2011 2012
2011 (n=57)2012 (n=43)
Post Match5
Interest in Applying IM in Practice
High to moderate interest in both the 2011 and 2012 groups.•Controls also had high to moderate interest.
* 2011 group had higher interest in applying IM in practice than controls (p=.001).
Notes:1. 2011 totals more than 100%– rounding
error
High/Moderate Neutral Some/None
0.9
0.11
77%
5%
19%
57%
23%20%
2011 2012 Controls
2011 (n=57)2012 (n=43)Control (n=30)
Implementation Strategies
Individual activities: • Free blocks of time longitudinally• Use concentrated time in certain rotations (orientation, community
medicine, integrative medicine, nursery). • Do content matched with rotations (e.g., outpatient pediatrics,
maternal child health, GYN, EM)
Group activities: • Wellness and self care• Videos• Motivational interviewing• Mind-Body skills training• Integration with behavioral
health program
• Field trips• Yoga, tai chi• OMT skills• Nutrition lecture series• Integrative approach to
lecture topics
Implementation Challenges
• Finding the time in the curriculum.
• Motivating some residents to keep on track and progress through the curriculum.
• Getting faculty interested in participating in the curriculum.
• Incorporating an Integrative Medicine approach into busy outpatient care sessions.
Implementation Successes
• Most residents are progressing well through the curriculum.
• Evaluations are very encouraging.
• One sites from the 2011 class is requesting continued access to the curriculum after graduation.
• The presence of the IMR attracts competitive residents to the pilot sites.
• Residents’ medical knowledge has increased from Yr. 01 to Yr. o2.
• Unknown:• Residents’ well-being• Patient centeredness• Patient outcomes• Practice patterns after graduation
Next Steps• Complete the Yr. 03 content
• Analyze Behavioral Assessments/residents’ well-being and compare with control groups
• Expand to other programs
• 5 early adopters in 2010• Medical Center of Central Georgia, Macon, GA
• Tufts University Family Medicine, Malden, MA
• Aurora Family Medicine Residency Program, Milwaukee, WI; Research Family Medicine, Kansas City, MO;
• Internal Medicine Residency University of New Mexico, Albuquerque NM.
• Build a stand alone course on Prevention and Wellness for residents and medical students
Discussion
AcknowledgementsUniversity of Arizona Pilot Sites
Emily Sherbrooke Mary Guerrera, M.D.
Paula Cook Ben Kligler, M.D., MPH
Rhonda Hallquist Craig Schneider, M.D.
Tieraona Low Dog, M.D. Raymond Teets, M.D.
Dael Waxman, M.D.
Teaching Strategies
Site Course Teaching Strategy Examples
U of A Physical ActivitySupplements
Yoga classVisit to health food store w/ cases & budget
Maine MC SupplementsNutrition
Visit to traditional herbalist storeTrip to chicken processing plant
U Conn Nutrition Lecture with sampling of various foods
Beth Israel
Nutrition Evening dinner discussion
Hennepin Stress and M-B Experience in PMR, hypnosis, breath work
Carolinas Physical ActivityStress and M-B
Ropes course w/ faculty during orientationMindfulness meditation sessions
U Texas Stress and M-B Lecture and acupuncture experience
Maine Gen
Clinical Integration
Patient joins the IMR case staffing